scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

scholarly journals Profile Of Children Referred To Primary Health Care Physiotherapy: A Longitudinal Observational Study In Norway

2020 ◽  
Author(s):  
Kari Anne I Evensen ◽  
Siw Sellæg ◽  
Anne-Cath Stræte ◽  
Anne E. Hansen ◽  
Ingebrigt Meisingset
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Observational Study ◽  
Motor Development ◽  
Daily Activities ◽  
Child Health Care ◽  
Longitudinal Observational Study ◽  
Primary Health

Abstract Background Children are referred to primary care physiotherapy services for a variety of reasons, ranging from concerns for motor development to the need for extensive habilitation services. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the variation in baseline demographical and clinical characteristics as well as treatment outcome at follow-up six months after baseline. Methods Children referred to primary care physiotherapy in a municipality in Norway were invited to participate in this longitudinal observational study. The children’s demographics, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum six months after baseline. Results Baseline characteristics were registered for 148 children by the physiotherapist and for 101 (68.2%) children by their parents. Half of the children were referred from child health care centres due to concerns for motor development, asymmetry and orthopaedic conditions, and most of these children were below the age of one year. There was partly agreement between causes of referral and the physiotherapists’ functional diagnoses. The children’s daily activities were little affected by the problem or complaint for which they were referred. About a third of the children needed only examination. Follow-up data was registered for 64 children. The majority achieved their main treatment goal and the treatment was carried out as planned. Conclusions This study describes the profile of a broad spectrum of children referred to physiotherapy in primary health care in Norway. Our findings may guide further interdisciplinary collaboration and knowledge transfer between professionals involved in child health care with the goal to balance the use of resources to the need for physiotherapy. Trial registration: ClinicalTrials.gov Identifier: NCT03626389. Registered on August 13th 2018 (retrospectively registered).

scholarly journals Rural-urban differences in the pattern of referrals to an asynchronous teledermatology service

10.3823/2571 ◽  
2018 ◽  
Vol 11 ◽  
Author(s):  
Josep Vidal-Alaball ◽  
Jacobo Mendioroz Peña ◽  
Glòria Sauch Valmaña
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Face To Face ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
The Face ◽  
Care Practices ◽  
Urban And Rural Areas ◽  
Primary Care Practices

Background Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres. Methods and findings A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices. Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p<0.001). The number of referrals to the face-to-face dermatology service after a teledermatology consultation decreased significantly in both urban [OR=0,81 (0,70-0,93) p=0,001] and rural centres [OR=0,64 (0,57-0,72) p<0,001]. Conclusions The asynchronous teledermatology service established in the Bages County increases the resolution of primary care teams as reduces referrals to the face-to-face dermatology service. This effect is more pronounced in rural than in urban areas. Such finding may indicate the need to prioritize telemedicine services in rural primary care practices.

Risk factors and features of stroke among young persons in urban and rural areas of the Tambov Region

2021 ◽  
pp. 45-52
Author(s):  
Ekaterina B. Zvonareva ◽  
Lubov I. Grigorova
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Cerebral Circulation ◽  
Young Patients ◽  
Clinical Hospital ◽  
Regional Features ◽  
Urban And Rural Areas ◽  
Concomitant Factors ◽  
Causes And Risk Factors

Since 2011 according to the national project “Health” the Regional Vascular Center has been operating on the basis of the Tambov Regional Clinical Hospital. This is a ward for patients with acute cerebral circulation disorder. Since 2017 there has been an increase in patients due to an increase in the number of attached population to Tambov Regional Clinical Hospital and, accordingly, unfortunately, the mortality rate from acute cerebral circulation disorder has been increasing. Between 2016 and 2020, a study was conducted based on the follow-up of young patients with hemorrhagic and ischemic stroke. In the study we emphasized the research of regional features of the structure, causes, and risk factors of stroke in persons in the city of Tambov and the districts of the Tambov Region. We verified pathogenetic subtypes of stroke among young patients. We identified and considered main and concomitant factors determining stroke outcome, degree of neurological deficiency, and disabled patients. We identified the leading causes of stroke in persons, the main of which were: arterial hypertension, cardiac pathology, atherosclerosis.

scholarly journals INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039004
Author(s):  
Tessa Roberts ◽  
Oye Gureje ◽  
Rangaswamy Thara ◽  
Gerard Hutchinson ◽  
Alex Cohen ◽  
...  
Keyword(s):  
Rural Areas ◽  
Help Seeking ◽  
Psychotic Disorders ◽  
Global South ◽  
Ethical Review ◽  
Target Populations ◽  
Key Stakeholders ◽  
Pilot Work ◽  
Urban And Rural Areas

IntroductionThere are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.MethodsINTREPID II is a programme of research incorporating incidence, case–control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.Ethics and disseminationInformed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.

Effectiveness of individual and group multicomponent interventions for smoking cessation in primary care: a quasi-experimental study

2019 ◽  
Vol 36 (5) ◽  
pp. 627-633 ◽  
Author(s):  
Juan Fernando Suárez-Varela Úbeda ◽  
Sara Rodríguez-Vázquez ◽  
José Antonio Ordóñez Barranco ◽  
Gilberto Vega Caldera ◽  
Pedro Pablo Pérez Alvárez ◽  
...  
Keyword(s):  
Higher Education ◽  
Primary Care ◽  
Smoking Cessation ◽  
Group Intervention ◽  
Drug Prescription ◽  
Intervention Group ◽  
Quasi Experimental ◽  
Primary Care Practices ◽  
Multicomponent Interventions

Abstract Background The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice. Objective To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices. Methods A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients. Results The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065–3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006–3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126–4.980, P < 0.05) were significantly associated with smoking cessation. Conclusions Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment.

scholarly journals Depression risk in patients with heart failure in primary care practices in Germany

2016 ◽  
Vol 28 (11) ◽  
pp. 1889-1894
Author(s):  
Marcel Konrad ◽  
Jens Bohlken ◽  
Michael A Rapp ◽  
Karel Kostev
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Insurance ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Study Population ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

Vaccine Hesitancy in Pediatric Primary Care Practices

2018 ◽  
Vol 28 (13) ◽  
pp. 2071-2080 ◽  
Author(s):  
Salini Mohanty ◽  
Amy Carroll-Scott ◽  
Marissa Wheeler ◽  
Cecilia Davis-Hayes ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Vaccine Hesitancy ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Multiple Strategies ◽  
Efficiency And Effectiveness ◽  
Care Practices ◽  
Barriers And Challenges ◽  
Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

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